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. 2024 Oct;26(5):774-779.
doi: 10.1007/s11307-024-01940-y. Epub 2024 Aug 1.

Interobserver Agreement Rates on CXCR4-Directed PET/CT in Patients with Marginal Zone Lymphoma

Rudolf A Werner #  1   2 , Yingjun Zhi #  3 , Niklas Dreher  4 , Samuel Samnick  4 , Aleksander Kosmala  4 , Takahiro Higuchi  4   5 , Lena Bundschuh  6 , Constantin Lapa  6 , Andreas K Buck  4 , Max S Topp  7 , Hermann Einsele  7 , Johannes Duell  7 , Sebastian E Serfling #  8 , Ralph A Bundschuh #  6
Affiliations

Interobserver Agreement Rates on CXCR4-Directed PET/CT in Patients with Marginal Zone Lymphoma

Rudolf A Werner et al. Mol Imaging Biol. 2024 Oct.

Abstract

C-X-C motif chemokine receptor 4 (CXCR4)-directed molecular imaging provides excellent read-out capabilities in patients with marginal zone lymphoma (MZL). We aimed to determine the interobserver agreement rate of CXCR4-targeted PET/CT among readers with different levels of experience.

Methods: 50 subjects with MZL underwent CXCR4-targeted PET/CT, which were reviewed by four readers (including two experienced and two less experienced observers). The following 8 parameters were investigated: overall scan result, CXCR4 density in lymphoma tissue, extranodal organ involvement, No. of affected extranodal organs and extranodal organ metastases, lymph node (LN) involvement and No. of affected LN areas and LN metastases. We applied intraclass correlation coefficients (ICC; < 0.4, poor; 0.4-0.59, fair; 0.6-0.74, good and > 0.74 excellent agreement rates).

Results: Among all readers, fair agreement was recorded for No. of affected extranodal organs (ICC, 0.40; 95% confidence interval [CI], 0.25-0.68), overall scan result (ICC, 0.42; 95%CI, 0.28-0.57), CXCR4 density in lymphoma tissue (ICC, 0.52; 95%CI, 0.38-0.66), and No. of extranodal organ metastases (ICC, 0.55; 95%CI, 0.41-0.61) and LN involvement (ICC, 0.59; 95%CI, 0.46-0.71). Good agreement rates were observed for No. of LN metastases (ICC, 0.71; 95%CI, 0.60-0.81) and No. of LN areas (ICC, 0.73; 95%CI, 0.63-0.82), while extranodal organ involvement (ICC, 0.35; 95%CI, 0.21-0.51) achieved poor concordance. On a reader-by-reader comparison, the experienced readers achieved significantly higher agreement rates in 4/8 (50%) investigated scan items (ICC, range, 0.21-0.90, P < / = 0.04). In the remaining 4/8 (50%), a similar trend with higher ICCs for the experienced readers was recorded (n.s.).

Conclusion: CXCR4-directed PET/CT mainly provided fair to good agreement rates for scan assessment, while a relevant level of experience seems to be required for an accurate imaging read-out.

Keywords: C-X-C motif chemokine receptor 4; CXCR4; Chemokine receptor; Marginal zone lymphoma; Theranostics.

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Figures

Fig. 1.
Fig. 1.
Forest plot for diagnostic scan parameters based on CXCR4-directed PET/CT. Extranodal parameters (organ involvement and number [No.] of affected organs) achieved poor concordance. The remaining parameters, however, achieved fair to good intraclass correlation coefficients (ICC).
Fig. 2.
Fig. 2.
66-year old subject diagnosed with nodal marginal zone lymphoma. As seen on the maximum intensity projection, there were nodal lymphoma manifestations above and below the diaphragm, along with a CXCR4-positive lymphoma manifestation in the intestine (transaxial CT and PET/CT on the bottom). This extranodal involvement was only identified by the experienced, but not by the less experienced readers, highlighting the challenge of interpreting manifestations outside of the nodal system using CXCR4-targeted PET/CT.
See this image and copyright information in PMC

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